On spectral-domain OCT of the macula, a patient with chronic central serous chorioretinopathy shows subretinal fluid, retinal pigment epithelium (RPE) detachment, and a highly reflective thickened choroid. The imaging finding that most specifically distinguishes pachychoroid from other maculopathies in this context is:

• A Full-thickness photoreceptor loss at the fovea
• B Multiple drusenoid PED confluent at the posterior pole
• C Hyper-reflective dots in the outer nuclear layer
• D Subfoveal choroidal thickness > 300 µm on enhanced depth imaging OCT ✓

Explanation

Pachychoroid spectrum diseases are defined by choroidal thickening (usually >300 µm on EDI-OCT), dilated outer choroidal (Haller's layer) vessels, and attenuation of inner choroidal (Sattler's and choriocapillaris) layers. This pachychoroid phenotype underlies chronic CSC and pachychoroid neovasculopathy. Full-thickness photoreceptor loss, drusenoid PEDs, and hyper-reflective dots are non-specific or point to other entities like AMD.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.